Cahit Kaçar

A co-occurrence of sarcoidosis and ankylosing spondylitis: a case report

Sarcoidosis is an inflammatory multi-system disease, which may cause articular involvement. By causing sacroiliitis, it may mimic spondyloarthropathies. A case with a co-occurrence of sarcoidosis and late-onset of typical ankylosing spondylitis was presented and a possible association between these two entities was discussed.

Quantitative sacroiliac joint scintigraphy in normal subjects and patients with sacroiliitis

The aim of this study is to determine the sacroiliac index (SII) of healthy subjects and to compare these values with patients having sacroiliitis (SI). Quantitative sacroiliac scintigraphy (QSS) was performed with Tc-99m hydroxy methylene diphosphonate (HMDP) and whole sacroiliac joint-to-sacrum ratio was calculated as a SII by the region of interest (ROI) method. Forty-seven nonarthritic healthy subjects and 13 patients with SI were studied. Effects of aging, gender and laterality on SII were evaluated in 47 healthy subjects.The sacroiliac index was higher in men than women (p < 0.05). SII did not change significantly in aged men, but it decreased significantly in aged women (p < 0.05). Eleven of 13 patients with SI had a higher SII than healthy subjects (> mean + 2SD). In the other two cases by using small ROIs, SIIs were found to be higher than the normal range. Our results suggest that QSS is a sensitive method for the diagnosis of early stage SI and every institution should establish its own normal SII.

Vitamin E and aerobic exercise: effects on physical performance in older adults

Background and aims: Aerobic endurance exercise enhances antioxidant defenses and improves the physical performance of older adults. However, the combined effect on physical performance of exercise and an antioxidant such as vitamin E has not been investigated. The purpose of this study was to evaluate the effects of six months of vitamin E supplementation and supervised aerobic training on physical performance and body composition in sedentary older adults. Methods: Fifty-seven adults, whose average age was 71.5±7.5 years, were randomly assigned to an exercise (E), exercise-vitamin (EV), control (C) or vitamin (V) group, and were evaluated before, halfway through, and after training. The dose of vitamin E was 900 IU/day. The training program comprised three sessions of walking exercise per week, at an intensity of 70% of heart rate reserve. Results: In the E and EV groups, the training program significantly reduced (p<0.016 for each) body weight and body mass index (BMI), and improved performance in the 6-min walk, chair stand, arm curl, and back scratch tests. Performance on the 6-min walk test improved in E and EV, but decreased in the V group. Performance on the chair stand test increased in the EV and E groups, but decreased in the V and C groups. Body weight and BMI decreased more in the EV group than in the C and V groups (p<0.016). Conclusions: Six months of vitamin E supplementation has no additive effect beyond that of aerobic training on indices of physical performance and body composition in older sedentary adults.

Which is the dominant factor for perception of rheumatic pain: meteorology or psychology?

It is believed that there is an association between the weather and rheumatic symptoms. We aimed to investigate what kind of association is present and what are the factors which determine the nature of this association. Fifty-six subjects with rheumatic disease (31 RA, 15 SpA, 10 OA) who live in Antalya were followed between December 2005 and July 2006. Patients were asked to fill diaries which contain questions regarding the symptoms of their rheumatic diseases everyday. In every monthly visit, disease activity measurement, laboratory assessment and Beck depression inventory assessment were recorded. The symptomatic and psychological measurements were matched with the meteorological data of Antalya Regional Directorate of Meteorological Service of Turkish State. Correlation of symptoms with weather variables was investigated. Contributory effect of weather and of psychologic factors on symptom scores were evaluated by stepwise multiple regression analysis. Eighty-four percent of subjects belive in an association between weather and rheumatism, while 57% claimed to have ability to forecast weather. The maximum correlation coefficient between weather and arthritis symptoms was −0.451 and the maximum contribution of weather on symptoms was 17.1%. Arthritis symptoms were significantly contributed by Beck depression score. The belief about presence of weather–arthritis association was found to be stronger than its statistical power. Our results did not prove or rule out the presence of weather–rheumatism association. As long as the scientific attempts result in failure, the intuitive support in favour of the presence of weather–arthritis association will go on forever.

Adverse effect of TNF-alpha blocker? Demyelination in an ankylosing spondylitis patient: a case report.

Anti‐tumour necrosis factor (TNF)‐alpha agents promise better disease control for treatment of inflammatory arthritides which are resistant to classical disease‐modifying treatment and provide better functional outcome. But these agents are not free of adverse events. The exact relationship between use of anti‐TNF drugs and development of demyelination cannot be established yet. Here we present a case of a 36‐year‐old man who developed demyelination in the cervical spinal cord while he was being treated with etanercept for ankylosing spondylitis.

Sacroiliac joint involvement in psoriasis

Psoriasis is a skin disorder that is associated with arthritis. Sacroiliac joint involvement is considered to be less frequent than the other types of psoriatic arthritis. Additionally, the psoriatic sacroiliitis is considered to be asymmetric in general. We aimed to define the frequency and type of sacroiliac involvement in patients with psoriasis. Patients with psoriasis were included the study. Characteristics of skin, nail and articular involvement were noted. Psoriasis area and severity index was calculated. Antero-posterior pelvic X-rays were obtained and graded by two rheumatologists and a radiologist independently. One hundred and thirty-three patients were included. Thirty-seven of patients (27%) have articular involvement symptomatically. The sacroiliac joint involvement was observed in 34 (26%) of patients. More than one-half of sacroiliac involvement was bilateral while less than one-half was in symptomatic patients regarding sacroiliitis. Fifty-seven percentages of all patients have psoriatic nail involvement. Sacroiliac joint involvement did not show any significant association with psoriatic nail involvement or the severity of skin disease. We found higher frequency of sacroiliac joint involvement and bilateral sacroiliitis in patients with psoriasis. This is in contrast to present information about the association of psoriasis and sacroiliitis. These findings need confirmation by further studies and with more sophisticated techniques such as magnetic resonance imaging.

Hydroxychloroquine-induced hyperpigmentation: a case report

The antimalarials are one of the most commonly prescribed drugs in medical practice, for conditions such as rheumatoid arthritis as well as malaria. They are generally well‐tolerated and the possible side effects of synthetic antimalarials, though infrequent, are well known. Besides the familiar adverse reactions, a localized mucocutaneous bluish‐grey to black discolouration can sometimes be seen with antimalarial drugs. The aim of this report was to draw attention to the localized mucocutaneous bluish‐grey hyperpigmentation induced by hydroxychloroquine with a case presentation and a review of the literature.

Oxidases and oxygenases in regulation of neutrophil redox pathways in Behçet’s disease patients

This study aimed to determine plasma and neutrophil oxidase activities that may contribute to vascular inflammation in Behçet’s disease (BD) patients. Cyclooxygenase (COX), NADPH oxidase and myeloperoxidase (MPO) activity was determined in neutrophils isolated from BD patients and healthy controls. Functional assay of NADPH oxidase was significantly increased in BD patients, both at basal conditions and in response to fMLP stimulation. There was a significant increase in plasma MPO activity in the disease group as compared to controls. Total COX activity was significantly increased in BD neutrophils. The increase in total COX activity was accompanied with enhanced activity of COX-2, differentiated by using the COX-1 isoform-specific inhibitor SC-560. Neutrophil nitrate/nitrite levels showed no significant difference in BD; however, plasma nitrate/nitrite contents in BD patients were significantly greater compared to controls. In conclusion, increased plasma MPO, neutrophil NADPH and COX activities may contribute to intravascular inflammation documented in BD patients.

Musculoskeletal sarcoidosis with a dermatologic clue for diagnosis: a case report

Sarcoidosis is a multisystem, inflammatory disorder characterized by infiltration of any organ with non-caseating granuloma. Clinical picture depends on which system(s) involved. Pulmonary, lymphatic and musculoskeletal systems are the most commonly affected systems. Skin is one of the frequently involved organs. Its involvement may provide a direct diagnostic clue. Here we have presented a young man with systemic sarcoidosis. The major complaint from him was the musculoskeletal pain. But the route to diagnosis starts from a lesion over the scalp.

2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis

In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.